Corporate Medical Coder-Coding Certificate required
Full Time
Phoenix, AZ
Posted
Job description
Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
Coordinates coding updates and assists in the establishment of reimbursement policies. Coordinates coding guidelines with medical policies and corresponding pricing functions. Researches, supports, and implements changes related to corporate reimbursement strategy to ensure appropriate, accurate, and predictable provider reimbursement.
REQUIRED QUALIFICATIONS
Required Work Experience
- 2 years of experience working for a healthcare organization / health insurer (All Levels)
Required Education
- High-School Diploma or GED in general field of study (All Levels)
Required Licenses
- N/A
Required Certifications
- Professional Coder Certification Exam, along with completion of the medical field experience requirement, resulting in certification from a professional coding institute/organization. (All Levels)
PREFERRED QUALIFICATIONS
- 3 years of experience working for a healthcare organization / health insurer (All Levels)
- 1 years of experience in an healthcare economics or payment integrity or actuarial field (All Levels)
- Experience with coding of all claim types (All Levels)
- Associate’s or Bachelor’s Degree in any general field of study. (All Levels)
- N/A
Preferred Certifications
- Specialty Coder Certifications, along with completion of the medical field experience requirement, resulting in additional certifications from a professional coding institute/organization. (All Levels)
ESSENTIAL job functions AND RESPONSIBILITIES
LEVEL 1
- Research and help resolve pricing and coding inquiries or issues (HCPC, CPT, ICD9/ICD10, modifiers etc.). Research and provide recommendations for coding guidelines, industry standard coding practices, billing issues, and reimbursement, taking into consideration possible business implications.
- Conduct coding and reimbursement research through the internet or various other sources, as available, including provider organizations, CMS, and other Blue Cross Blue Shield Plans.
- Research claims submissions for appropriate billing practices. Help identify and communicate fraud and abuse issues related to coding.
- Participate in the development of monthly, quarterly and annual coding updates. Track all potential coding changes, documenting details and decision points thoroughly, including timing and interdependencies with other coding, configuration or pricing processes. Review all potential changes with management or peers prior to finalization.
- Compile the monthly, quarterly and annual coding updates in a timely manner and with 100% accuracy. Audit the implementation of coding updates to ensure accuracy and consistency with established reimbursement and coding policies.
- Develop, maintain and follow detailed procedures on the process and business rules around coding changes.
- Provide timely research and support for claims and customer service representatives' pricing questions.
- Ensure timely and accurate maintenance of coding-related documentation for internal and external users.
- Coordinate reimbursement and coding documentation updates and assist in the establishment of reimbursement policies.
- Coordinate coding guidelines with medical policies and corresponding pricing functions.
- Constantly pursue process and documentation improvements that will reduce or eliminate the potential for manual errors. Proactively partner with others to develop technical solutions to automate or streamline standard processes or decision points.
- Attend pertinent coding seminars and training, and use other resources as applicable, to maintain current knowledge of rapidly changing coding guidelines.
- Set up all work in such a way that it can be easily reviewed and recreated.
LEVEL 2
- Proactively review and identify potential revisions to existing coding and reimbursement rules and methodologies for improved consistency, thoroughness, accuracy and appropriateness. Constantly review CMS guidelines, other industry coding and reimbursement standards, online reference material, coding-related publications, and training material as part of this process
- Participate in the analysis and support of the claim editing software, including obtaining edit clarification and coordinating coding and customization changes.
- Develop and maintain a thorough understanding of how coding decisions affect pricing, reimbursement or other production processes. Become a Subject Matter Expert on and maintain documentation of these interdependencies.
- Develop clear and concise recommendations for any potential coding or reimbursement changes including full rationalization and how it might interact with current processes and policies.
- Independently represent coding and reimbursement team interests on cross-divisional committees or projects.
- Participate in the annual DRG taskforce to identify new diagnosis codes, DRG and procedure codes for appropriate system action, providing critical guidance and support from the initial review and interpretation of CMS proposed changes through implementation of final DRG base rates.
- Participate on the fee schedule team to develop market appropriate fees for all new and existing procedure codes, including annual professional and outpatient fee schedule updates. In addition to team participation, participate subgroup to develop fee recommendations for non-CMS priced procedures without fees.
- Provide diagnosis code and code edit information for system and production support, which includes coordinating the pre-existing and waiver flags within the claims systems.
- Demonstrate complete ownership and accountability in all leadership roles, process improvements and recommendations.
- Develop clear and concise recommendations for any potential coding or reimbursement changes including full rationalization and how it might interact with current processes and policies. Present recommendations to the appropriate audience for review and approval.
- Work closely with other areas of the company to ensure implementation and updates to methodologies are made timely and accurately.
- Share knowledge of skills, projects, and business needs with peers and less experienced analysts. Trains new analysts as needed
LEAD
- Plan and lead multiple projects and cross-functional teams from inception to completion. This includes working independently on creating timelines, working with other areas to define deliverables, monitoring progress, implementing the project and resolving/monitoring post-implementation issues.
- Lead and/or participate on task teams and corporate committees as required, applying analytical skills and actively participating in a team environment to complete projects and accomplish goals.
- Demonstrate a strong business perspective, industry-knowledge, organizational skills and communication skills. Work with and present to all levels of management, including Executives.
- Using available organizational resources, independently initiates, performs and/or supervises necessary analysis and gathers feedback from key stakeholders to support recommended changes or corrections to current policy. Demonstrates understanding of customer priorities and other internal considerations when determining prioritization. Presents results and recommendations to the appropriate team or Executive for approval, and administers implementation.
- Independently manage and improve organizational processes. Evaluate and create new ways to do things while making sure to incorporate input from all key stakeholders. Keeps abreast of trends or technology that could improve work flow.
- Demonstrate complete ownership and accountability in all leadership roles, process improvements and recommendations.
- Identify and explore opportunities for reimbursement policy changes that support claim savings goals, while maintaining focus on appropriate reimbursement levels and relativities.
- Perform independent research to identify coding and system issues that impact pricing, presenting recommendations for appropriate corrective measures to management following thorough analysis & independent decision, while actively participating in the resolution.
- Act as liaison to external vendor for claim editing software, coordinating all communication, obtaining edit clarifications, coordinating coding and customization changes.
- Act as a liaison with health services, other divisions, external vendors and analysts to assure adequate communication and coordination of reimbursement and coding changes.
- Collaborate with trend analyst to define reporting criteria to evaluate shifts in utilization and provider coding patterns.
- Support and train other employees in lower levels. Help direct a thorough and efficient review of all coding and reimbursement work being produced in the area.
ALL LEVELS
- Reports to a supervisor or manager who provides minimal supervision/project management. Develop own work-plans, and discusses timelines, prioritization, and objectives with supervisor or manager.
- Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels.
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Perform all other duties as assigned.
Competencies
REQUIRED COMPETENCIES
Required Job Skills (All Levels)
- Intermediate skill in use of office equipment, including copiers, fax machines, scanners and telephones
- Intermediate PC proficiency
- Intermediate proficiency in spreadsheet and word processing software
- Basic skill in mathematics
Required Professional Competencies (All Levels)
- Broad understanding of health insurance terms and concepts
- General knowledge of the healthcare industry
- Knowledge of coding principles and code sets including UB92, CPT, HCPCS , ICD 9/10, ADA, and ASA
- Knowledge of UB92 guidelines. Knowledge of Medicare rules and regulations
- Ability to deal with ambiguity and make recommendations with less than complete or conflicting information while maintaining appropriate time management
- Ability to maintain confidentiality and privacy
- Ability to communicate effectively, both orally and in writing, to peers and direct management
- Ability to build and maintain productive working relationships with others
- Skill in prioritizing tasks and working with multiple priorities, sometimes under limited time constraints
- Ability to summarize coding information to a general audience
- Proactive about requesting enough information to fully understand and meet the business need
- Analytical knowledge necessary to generate reports based on available data and then make sound decisions based on reported data (Lead)
- Ability to deal with ambiguity and make recommendations with less than complete or conflicting information while maintaining appropriate time management. (Lead)
Required Leadership Experience and Competencies (All Levels)
- N/A
PREFERRED COMPETENCIES
Preferred Job Skills (All Levels)
- Advanced skill in use of office equipment, including copiers, fax machines, scanner and telephones
- Knowledge of BCBSAZ corporate structure, functions, and procedures
- Advanced proficiency in spreadsheet and word processing software
- In-Depth knowledge of BCBSAZ products, processing systems, files, and computer software
Preferred Professional Competencies (All Levels)
- Knowledge of fee schedules
- Ability to communicate effectively, both orally and in writing, to all levels in all departments
- Project management skill needed to create timelines, track deliverables and progress, resolve issues, and communicate project status
Preferred Leadership Experience and Competencies (All Levels)
- N/A
Our Commitment
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.
colinoncars.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, colinoncars.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, colinoncars.com is the ideal place to find your next job.